Primary gingival tuberculosis: A rare clinical entity

Abstract

Tuberculosis is a specific granulomatous infectious disease and a major cause of death in developing countries. Primary gingival tuberculosis is extremely rare and forgotten entity. Oral lesions usually appear as secondary to primary tuberculosis infection elsewhere. The lesion may take the form of nodules, ulcers, or elevated fissures. We report a case of primary tuberculosis of gingiva, manifesting as gingival enlargement with ulceration and discharge. Diagnosis was based on histopathologic examination, complete blood count, chest X-ray, and immunologic investigations with detection of antibodies against Mycobacterium tuberculosis. With the recent increase in the incidence of tuberculosis, this case report also emphasizes the need for clinicians to be aware of this possibility, consider tuberculosis in the differential diagnosis of gingival enlargement, and thus, play a role in the early detection of this disease.

Utility of fine needle aspiration cytology to diagnose intraoral tuberculosis and other oral granulomatous lesions

“…Foreign body granuloma was reported as the most common cause of oral cavity granulomata in a study by Gupta et al Other than OTB, foreign body granuloma was the most common OGL in our study. The foreign body reaction can be triggered by an endogenous substance such as hair fibres, keratin aggregates, and lipids derived from cholesterol deposits, or an exogenous substance such as dental materials, retained sutures, and cosmetic filler substances (ie, hyaluronic acid) …”

Oral ulcer: an uncommon site in primary tuberculosis

“…Tuberculosis (TB) is a chronic infectious disease caused by Mycobacterium tuberculosis . About one‐third of the world's population is affected, with eight million people infected annually and three million dying per year from tuberculosis complications …”

“…Pulmonary tuberculosis remains the most common form of the disease but other sites may be involved, including the lymphatic, skeletal and central nervous systems, the skin, kidneys, pharynx and gastrointestinal tract . Extrapulmonary involvement in tuberculosis is uncommon, accounting for approximately 10% to 15% of all infected people . The global prevalence of human TB due to Mycobacterium bovis has been estimated at 3.1% of all human TB cases …”

“…Most cases appear as a chronic painless ulcer . Primary oral tuberculosis without pulmonary involvement is extremely rare since most oral lesions represent a secondary infection from initial pulmonary lesions …”

“…Primary oral tuberculosis is more common in younger patients . When present, it usually involves the gingiva, mucobuccal fold and areas of inflammation adjacent to teeth or in extraction sites, with enlarged palpable cervical lymph nodes . However, secondary oral tuberculosis is mostly present on the tongue, lips, buccal mucosa and rarely on the palate, gingival mucosa and lingual frenum …”